Provider Demographics
NPI:1417432568
Name:DECKER, WILLIAM WYATT (PHARMD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:WYATT
Last Name:DECKER
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2725 NE JOHN OLSEN AVE APT C33
Mailing Address - Street 2:
Mailing Address - City:HILLSBORO
Mailing Address - State:OR
Mailing Address - Zip Code:97124-7174
Mailing Address - Country:US
Mailing Address - Phone:541-604-1681
Mailing Address - Fax:
Practice Address - Street 1:14625 SW ALLEN BLVD
Practice Address - Street 2:
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97007-3697
Practice Address - Country:US
Practice Address - Phone:503-590-7346
Practice Address - Fax:503-590-2584
Is Sole Proprietor?:No
Enumeration Date:2018-09-25
Last Update Date:2018-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORRPH-0016875183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist